Healthcare Provider Details

I. General information

NPI: 1881901163
Provider Name (Legal Business Name): JAMES ERIC GARDNER, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 MADISON AVE SUITE 300
MEMPHIS TN
38104-6492
US

IV. Provider business mailing address

1750 MADISON AVE SUITE 300
MEMPHIS TN
38104-6492
US

V. Phone/Fax

Practice location:
  • Phone: 901-861-8088
  • Fax:
Mailing address:
  • Phone: 901-861-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35417
License Number StateTN

VIII. Authorized Official

Name: DR. JAMES GARDNER
Title or Position: PRESIDENT
Credential: MD
Phone: 901-861-8088